Risk Adjustment Toolkit

by Episource

(7 ratings)

HCC Risk Adjustment Analytics Toolkit for Medicare Advantage and more

Episource’s Risk Adjustment Toolkit for Microsoft Excel delivers a comprehensive set of tools for analyzing Medicare Advantage risk adjustment data. The Excel add-in empowers health plans and provider groups to better understand their members’ risk scores, identify Dx/HCC gaps, and track risk program ROI.


● Calculate member risk scores and forecast premiums based on demographic and diagnosis information

● Perform analysis on Dx codes and/or HCCs

● Get descriptions and reference details about Dx codes or HCCs without leaving Excel

● Identify Year-over-Year HCC gaps and calculate their financial impacts

● Calculate impact and ROI of incremental codes identified in risk adjustment programs

● Full implementation of the CMS HCC Models from v22 to v24, including hierarchies, age/sex edits, and interaction codes

● Coverage of all risk factor types (Community, Dual/Disabled, Institutional, Newly Enrolled, etc.)

Episource: Simplifying Healthcare

Episource is the industry leader in Risk Adjustment software and solutions, serving the nation’s largest health plans and provider groups with analytics, submissions, chart retrieval and HCC coding, and health risk assessments. We arm our clients with elegantly simple data, tools, and insights; empowering them to navigate the chaos of the healthcare system.

App capabilities

When this app is used, it
  • Can read and make changes to your document
  • Can send data over the Internet

At a glance